By Steve Spencer
For millions of Americans, breathing through the nose is a daily struggle. Some deal with a nose that seems to pinch shut with every breath; others are never more than an arm’s reach from a box of tissues. For years, more severe cases led to the operating room — general anesthesia, nasal packing, and weeks of recovery. Now, two newer in-office procedures are beginning to change that calculus.
John Stafford, MD, an otolaryngologist with ENT Associates in Birmingham, is now offering both VivAer and RhinAer to eligible patients. Each uses radiofrequency ablation to address a distinct nasal problem. And each can be completed in an exam room in 30 to 40 minutes, most of which is numbing time.
VivAer is designed for patients with nasal valve collapse, which occurs when the nasal cartilage buckles inward during inhalation, restricting airflow. RhinAer addresses an overactive nerve that drives chronic runny nose unrelated to allergies.
In the office, the patient experience is similar for both procedures. A topical numbing spray is applied first, followed by cotton pledgets soaked in anesthetic gel that sit in the nose for 15 to 20 minutes. A small injection of local anesthetic follows. The actual procedure then takes five to 10 minutes. Most patients can drive themselves home the same day, or return to work that afternoon.
With patients who have difficulty breathing through their nose, Stafford asks them to life the side of their cheek. This props open the nasal cartilage that would otherwise collapse on inhalation, so if they breath better, they are candidate for the VivAer procedure.
Not every patient is a candidate for the office-based option. People who have suffered significant nasal trauma affecting the septum may require a more involved correction such as septoplasty or functional rhinoplasty. For those patients, the tradeoff of a longer recovery is justified by the degree of structural repair needed. But for patients without major damage, VivAer can deliver comparable results with none of the downtime.
Stafford’s starting point with a new patient is medical management. Steroid and antihistamine nasal sprays are first-line for most nasal complaints. For chronic runny nose, a dedicated prescription spray is often sufficient. Stafford takes care to distinguish these from over-the-counter decongestants like Afrin, which can cause rebound congestion with regular use.
“Prescription nasal sprays don’t have the same problem of rebound congestion,” he said. “They’ve demonstrated safety in long-term use and they actually do better the more consistent you are with the use of them.”
Procedures become the next step when medications fall short. Before offering RhinAer, Stafford’s patients undergo an allergy evaluation first, and only those with persistent, non-allergic runny nose move forward to the procedure.
Both procedures have been available since around 2020. Initially classified as experimental by insurers and used primarily in academic centers, they have since moved into community practice as long-term data was accumulated. Three-year outcomes show that 90 percent of patients treated with either VivAer or RhinAer continue to experience significant relief — numbers Stafford said are consistent with what he observes in his own practice.
“Most people say they’re so thankful for the RhinAer in particular,” he said. “They’re no longer carrying around a bunch of tissues and blowing their nose all the time. And the VivAer patients are telling me they can finally breathe.
“If someone struggles with these things, but they’ve been afraid to move forward because they’ve heard bad things about nose surgeries, this is good news to find out that there are options we can do in the office with minimal downtime, none of the packing. I think these are great treatment options for a number of patients.”
